Active NPI
Christian T Wagner, MD
- Diagnostic Radiology Physician
- Worcester, MA
National Provider Identifier
1053372987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 202641
- Practice address
- 135 Gold Star Blvd
Worcester, MA 01606 - Phone
- (508) 853-2716
- Fax
- (508) 856-9025
- NPI assigned
- Mar 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 202641 | MA | Primary |
Addresses
Primary practice location
135 Gold Star Blvd
Worcester, MA 01606
Mailing address
630 Plantation St
Attn Physician Services Wot 12TH Floor
Worcester, MA 01605
Phone (508) 368-5529
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3204235 | Other | MEDICAID WELFARE | |
| 44949 | Other | FALLON COMMUNITY HEALTH P | |
| 784219 | Other | MVP HEALTH CARE | |
| A30514 | Other | MEDICARE B | |
| 7370306 | Other | AETNA US HEALTHCARE | |
| 3204235 | Other | HEALTHY START | |
| 3204235 | Medicaid | MA | |
| 7200046 | Other | CIGNA HEALTH PLAN | |
| AA5533 | Other | HARVARD PILGRIM HEALTHCAR | |
| J21993 | Other | BLUE SHIELD INDEMNITY | |
| 1818742 | Other | FIRST HEALTH | |
| J21993 | Other | BLUE CARE ELECT | |
| J21993 | Other | BLUE SHIELD HMO BLUE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202641 | MA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Worcester, MA
- NPI 1295827962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1053372987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 PLANTATION ST",
"address_2": "ATTN PHYSICIAN SERVICES WOT 12TH FLOOR",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-368-5529",
"fax_number": "508-368-5530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 GOLD STAR BLVD",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-853-2716",
"fax_number": "508-856-9025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "CHRISTIAN",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-30",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MA",
"license": "202641",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID WELFARE",
"identifier": "3204235",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "44949",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTH CARE",
"identifier": "784219",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE B",
"identifier": "A30514",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "7370306",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY START",
"identifier": "3204235",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3204235",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH PLAN",
"identifier": "7200046",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTHCAR",
"identifier": "AA5533",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDEMNITY",
"identifier": "J21993",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1818742",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "J21993",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD HMO BLUE",
"identifier": "J21993",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.